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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Assist (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in TN. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Assist (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Assist (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.70. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellcare Assist (HMO-POS) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $19.00 copay for preferred generic drugs at a preferred pharmacy. Specialty tier drugs have no copay.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers a wide range of benefits with varying cost-sharing options. The plan includes coverage for inpatient hospital stays, outpatient services, and emergency care, with copays ranging from $0 to $325 depending on the service. Additionally, the plan provides coverage for primary care, preventive services, and services such as hearing, vision, and dental, often with no copay or low copays. This plan also includes coverage for services like ambulance, transportation, and home health, as well as medical equipment and diagnostic services. Some services, such as home infusion, dialysis, and therapeutic radiology, involve coinsurance. The plan also offers additional benefits like OTC items and a meal benefit, and a few other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a $275 copay for days 1-6, and no copay for days 7-90. Additional days and non-Medicare-covered stays for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$280, Observation Services with a copay of $125-$280, Ambulatory Surgical Center (ASC) Services with a $125 copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
The Wellcare Assist (HMO-POS) plan covers ambulance services with a $300 copay for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered with no copay for up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Assist (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, and physician specialist services with a $15 copay. Mental health specialty services have a $40 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $15 copay. Additional telehealth benefits have a copay between $0 and $40, and opioid treatment program services have a $15 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Wellcare Assist (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay, while kidney disease education services have a 20% coinsurance.
Hearing Services See details
Wellcare Assist (HMO-POS) covers hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, but prescription hearing aids are covered up to $1500 per year with no copay, and OTC hearing aids are not covered. Prescription hearing aids are partially covered as the inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $15, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $200 per year.
Dental Services See details
The Wellcare Assist (HMO-POS) plan covers Medicare Dental Services with a $15 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a maximum of $5000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Assist (HMO-POS) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with prior authorization required, while the plan covers Prosthetic Devices and Medical Supplies with a 20% coinsurance and no copay. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Wellcare Assist (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $20, and lab services with no copay. Outpatient X-Ray services have a $25 copay, while therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Assist (HMO-POS) plan, but the plan does not cover any of the sub-services. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist (HMO-POS) plan, but require prior authorization. For days 1-20 and 51-100, there is no copay, and for days 21-50, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefit coverage. OTC Items have no copay and a maximum benefit of $200 every three months. The Meal Benefit also has no copay, but a doctor's referral is required. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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